Identification of early predictors of clinical remission in primary membranous nephropathy: a post-hoc analysis of the STARMEN trial

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Identified Weaknesses

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Paper Summary

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Three Markers Combined Predict Remission in Kidney Disease (But Small Study Needs Confirmation)

In a small post-hoc analysis of a clinical trial, researchers found that a combination of 24-hour proteinuria, serum creatinine, and immunological status at 3 months after starting immunosuppressive therapy could predict clinical remission of membranous nephropathy at 2 years. The combined model performed better than individual markers, but the small sample size, limited follow-up, and potential conflicts of interest require further validation in larger studies.

Possible Conflicts of Interest

Several authors declared receiving consulting fees, payments for lectures, grants, royalties, or participation in advisory boards from pharmaceutical companies like Novartis, SOBI, Alexion, Vifor, GSK, Otsuka, Samsung, Sanofi, Mundipharma, and AstraZeneca. These potential conflicts of interest should be considered when interpreting the results.

Identified Weaknesses

Short follow-up

The study only had a follow-up period of 2 years. Longer follow-up is needed to assess the long-term predictive value of the model.

Small sample size

The sample size of the STARMEN trial was small (n=86), which limits the generalizability of the findings. External validation in larger cohorts is needed.

Missing anti-PLA2R data

Not all patients had anti-PLA2R assessments, which might affect the results regarding the importance of the inclusion of anti-PLA2R status in the predictive model

Post-hoc analysis

This was a post-hoc analysis. Post-hoc analyses have a higher risk of bias and can overestimate effect sizes. The predictive model needs to be validated in an independent cohort.

Rating Explanation

The study presents a potentially useful predictive model, but the small sample size, post-hoc nature of the analysis, short follow-up, and potential conflicts of interest warrant a moderate rating. External validation is crucial.

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